Expert Commentary:
Time of the Essence When Transferring Heart Attack Patients Between Hospitals

(Philadelphia, PA) – In an editorial in the February 15th issue
of Circulation, Howard C. Herrmann, MD, Director
of Interventional Cardiology & the Cardiac Catheterization Laboratory
at the Hospital of the University of Pennsylvania, notes
time is a critical factor in determining the risk/benefit to heart-attack
patients when transferring them to a hospital that can perform angioplasty
(surgical repair of a blood vessel). Indeed, should these patients, who
present with acute ST-elevation myocardial infraction (STEMI), be routinely
transferred from hospitals without a catheterization lab to facilities
equipped with one to perform immediate angioplasty rather than receive
medical therapy at the initial hospital?

Several recent trials have concluded that angioplasty is better than fibrinolysis
(the process of breaking up and dissolving blood clots using medications)
in treating acute STEMI patients, and that even with an added transfer
time to another hospital, it still retains an advantage.

However, in this issue of Circulation, a 2005 study (Nallamothu
et al.) evaluated transfer times of more than 4,200 patients and found
that there was an average delay time of 180 minutes from the time a patient
presented at a hospital to the time they underwent angioplasty after transfer
to another facility capable of immediate angioplasty, also know as door-to-balloon
time. This is double the recommended amount of time – 90 minutes
– from presentation to catheterization, according to American College
of Cardiology/American Heart Association guidelines.

“These time delays are dramatic and could mean the difference between
life and death for some of these patients,” says Dr. Herrmann. “That’s
why it is too early to recommend routine transfers for primary angioplasties
for all patients presenting with STEMI, until protocols are put in place
to ensure rapid transfer times.”

Dr. Herrmann suggests putting into place common practices already performed
in some European countries and in isolated areas in the U.S. These practices
include: better identifying those patients who would benefit most from
transfer, optimizing communication systems to include early mobilization
of the cardiac catheterization team in the transfer hospital, minimizing
delays on arrival at the transfer hospitals to the catheterization laboratory,
and possibly creating specialized centers utilizing the latest advanced
therapies.

“Although the rapid performance of angioplasty may be the best treatment
for most patients with acute MI, delays in its application may make alternatives,
including thrombolysis, a better choice for some patients,” adds
Dr. Herrmann.

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Editor’s Notes: Dr. Herrmann is available
for interviews on this position.

The University of Pennsylvania has an on-campus television studio
with satellite uplink, live-shot capability for interviews with Penn experts.

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